1. Racialized economic segregation and potentially preventable hospitalizations among Medicaid/CHIP-enrolled children
- Author
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Smith, Laura Barrie, O'Brien, Claire, Kenney, Genevieve M., Tabb, Loni Philip, Verdeflor, Alaisha, Wei, Keqin, Lynch, Victoria, and Waidmann, Timothy
- Subjects
Hospital care -- Analysis ,Medicaid -- Services ,Children -- Health aspects ,Medical care -- Demographic aspects -- Access control -- United States ,Business ,Health care industry - Abstract
Objective: To examine geographic variation in preventable hospitalizations among Medicaid/CHIP-enrolled children and to test the association between preventable hospitalizations and a novel measure of racialized economic segregation, which captures residential segregation within ZIP codes based on race and income simultaneously. Data Sources: We supplement claims and enrollment data from the Transformed Medicaid Statistical Information System (T-MSIS) representing over 12 million Medicaid/CHIP enrollees in 24 states with data from the Public Health Disparities Geocoding Project measuring racialized economic segregation. Study Design: We measure preventable hospitalizations by ZIP code among children. We use logistic regression to estimate the association between ZIP code-level measures of racialized economic segregation and preventable hospitalizations, controlling for sex, age, rurality, eligibility group, managed care plan type, and state. Data Extraction Methods: We include children ages 0-17 continuously enrolled in Medicaid/CHIP throughout 2018. We use validated algorithms to identify preventable hospitalizations, which account for characteristics of the pediatric population and exclude children with certain underlying conditions. Principal Findings: Preventable hospitalizations vary substantially across ZIP codes, and a quarter of ZIP codes have rates exceeding 150 hospitalizations per 100,000 Medicaid-enrolled children per year. Preventable hospitalization rates vary significantly by level of racialized economic segregation: children living in the ZIP codes that have the highest concentration of low-income, non-Hispanic Black residents have adjusted rates of 181 per 100,000 children, compared to 110 per 100,000 for children in ZIP codes that have the highest concentration of high-income, non-Hispanic white residents (p < 0.01). This pattern is driven by asthma-related preventable hospitalizations. Conclusions: Medicaid-enrolled children's risk of preventable hospitalizations depends on where they live, and children in economically and racially segregated neighborhoods--specifically those with higher concentrations of low-income, non-Hispanic Black residents-are at particularly high risk. It will be important to identify and implement Medicaid/CHIP and other policies that increase access to high-quality preventive care and that address structural drivers of children's health inequities. KEYWORDS child and adolescent health, CHIP, health care disparities, health equity, index of concentration at the extremes, Medicaid, racial/ethnic differences in health and health care, racialized economic segregation, social determinants of health What is known on this topic * Little evidence exists on the importance of where children live for their access to and quality of health care in Medicaid and the Children's Health Insurance Program (CHIP). * High rates of preventable hospitalizations may be indicative of poor access to high-quality outpatient care, but little research has examined preventable hospitalizations among Medicaid/CHIP-enrolled children. * Studies examining preventable hospitalizations have focused on adult populations, are often limited to one state, and have not considered the effects of segregation based on both racial and economic privilege. What this study adds * We assess ZIP code level patterns of preventable hospitalizations for over 12 million Medicaid/CHIP-covered children across 24 states and document considerable across- and within-state variation. * We find a strong association between ZIP code-level racial and economic privilege, using an Index of Concentration at the Extremes measure for racialized economic segregation, and preventable hospitalizations among children. * Our findings demonstrate the need for tailored policy changes within Medicaid/CHIP, and investments to address structural inequities related to segregation, to improve outcomes for children living in less privileged neighborhoods., 1 | INTRODUCTION Children who live in different neighborhoods across the United States face different conditions of daily life and have different access to the resources they need to thrive, [...]
- Published
- 2023
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